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Effective November 10, 2026: Clinical Policies

Date: 08/11/26

Wellcare By Allwell and Wellcare By Superior HealthPlan (Duals) has approved policies to ensure medical necessity review criteria is current and appropriate for members and the scope of services provided. As a result, the following policies are effective on November 10, 2026, at 12:00 AM.

Policy

Applicable Products

New Policy Overview or Updated Policy Revisions

Allogeneic Hematopoietic Progenitor Cell Therapy

(MC.CP.MP.249)

Wellcare By Allwell (Medicare) and Wellcare By Superior HealthPlan (Duals)

Policy Updates Include:
  • Annual review
  • Coding and descriptions reviewed
  • References reviewed and updated
  • Reviewed by internal specialist and external specialist

Skin and Soft Tissue Substitutes

(MC.CP.MP.185)

Wellcare By Allwell (Medicare) and Wellcare By Superior HealthPlan (Duals)

Policy Updates Include:
  • In policy statements IV. to VIII., corrected “non-Medicare health plans” to “Medicare health plans”
  • Corrected the 03/26 revision log to note that code Q4432 was added to HCPCS code table 3

Transplant Service Documentation Requirements

(MC.CP.MP.247)

Wellcare By Allwell (Medicare) and Wellcare By Superior HealthPlan (Duals)

Policy Updates Include:

  • Updated note under criteria section I. stating “Approved requests for transplant evaluation are effective  for six months. After six months  have  passed, a new authorization is required” to “Approved requests for transplant evaluations are effective for 12 months. After 12 months have passed, a new authorization is required”

To review all policies, please visit Medicare Prior-Authorization Clinical Policies webpage.

Prior to updates, the policies were approved for use by Medicare Quality Committee.

For questions or additional information, please contact Provider Services at: